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		<title>Top 10
				JMIR Articles
		(In the Last Month)
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                    <title>Online Survey on Twitter: A Urological Experience</title>
                    <description><![CDATA[After my return from the Annual Congress of the American Urological Association in San Diego (May 3-8, 2013), I would like to congratulate McKendrick et al [1] and Hanson et al [2] on their recent papers on the impact of Twitter, one of the most common social media, in the medical and non-medical fields. In their elegant communications, both groups of authors stressed the role of the Internet and the Web as new methods of publicizing scientific data. Starting from the use of Twitter during a medical conference, McKendrick et al reported their first experience of using social media as supports for conference organizers, highlighting the use of a Twitter stream as an integral part of the communication structure of a conference on anesthetics. Hanson et al reported a Twitter-based surveillance method for monitoring public health regarding the use and abuse of a psychostimulant drug, emphasizing the potential role of this social media in collecting data for a survey.

To confirm these findings and encourage the use of these novel tools “to do science”, I would like to share a personal pioneering experiment I carried out during the Annual Congress of the European Association of Urology (March 2013, in Milan) and the recent American Congress in San Diego. During the meetings, I launched an online survey using Twitter, and posted an interactive specific urological question concerning the choice of preferred approach to robotic radical prostatectomy, the most recent and widespread surgical intervention for prostate cancer. The tweet was: “ONLINE-SURVEY: Do you perform ONLY Transperitoneal (T), ONLY Extraperitoneal (E) or BOTH approaches to dVP? (dVP= Da Vinci robotic prostatectomy) ReTweet T, E or TE” (Figure 1).

I used two specific hashtags (#EAU2013 for Milan, and #AUA2013 for San Diego).

In the course of both congresses, I received no fewer than 326 answers. Considering the absolute number of participants (approximately 18,000 in both congresses) the percentage of Tweets received (about 2%) may seem very low, but considering that it was a first "urological" experience, I think it may be significant.

Evaluating the survey results, 81 out of the 326 urologists (24.9% of those who used Twitter and retweeted me their answers!) perform both procedures. In 165 cases (50.6%), the preferred approach to robotic prostatectomy is transperitoneal.

I presented the results of this survey during my podium lecture in San Diego.

Obviously, my study is not a scientific survey without biases, but it did reveal the spread of social media, to the scientific community too.

In my opinion, this simple experiment not only confirms your own considerations about the use of social media, but also helps all of us to appreciate the fact that Twitter, like Facebook, Google+, Linkedin and all the other Web-linked social tools, is not limited to young people “chatting about love or friends”, but are novel instruments which can be used to even greater scientific advantage.<br /><br />
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                                    <link>https://www.jmir.org/2013/10/e238</link>
                    <pubDate>Fri, 25 Oct 2013 10:59:01 EDT</pubDate>
                    <guid>https://www.jmir.org/2013/10/e238</guid>
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                    <title>The Burden of a Remote Trial in a Nursing Home Setting: Qualitative Study</title>
                    <description><![CDATA[Background: Despite an aging population, older adults are typically underrecruited in clinical trials, often because of the perceived burden associated with participation, particularly travel associated with clinic visits. Conducting a clinical trial remotely presents an opportunity to leverage mobile and wearable technologies to bring the research to the patient. However, the burden associated with shifting clinical research to a remote site requires exploration. While a remote trial may reduce patient burden, the extent to which this shifts burden on the other stakeholders needs to be investigated. Objective: The aim of this study was to explore the burden associated with a remote trial in a nursing home setting on both staff and residents. Methods: Using results from a grounded analysis of qualitative data, this study explored and characterized the burden associated with a remote trial conducted in a nursing home in Dublin, Ireland. A total of 11 residents were recruited to participate in this trial (mean age: 80 years; age range: 67-93 years). To support research activities, we also recruited 10 nursing home staff members, including health care assistants, an activities co-ordinator, and senior nurses. This study captured the lived experience of this remote trial among staff and residents and explored the burden associated with participation. At the end of the trial, a total of 6 residents and 8 members of staff participated in semistructured interviews (n=14). They reviewed clinical data generated by mobile and wearable devices and reflected upon their trial-related experiences. Results: Staff reported extensive burden in fulfilling their roles and responsibilities to support activities of the trial. Among staff, we found eight key characteristics of burden: (1) comprehension, (2) time, (3) communication, (4) emotional load, (5) cognitive load, (6) research engagement, (7) logistical burden, and (8) product accountability. Residents reported comparatively less burden. Among residents, we found only four key characteristics of burden: (1) comprehension, (2) adherence, (3) emotional load, and (4) personal space. Conclusions: A remote trial in a nursing home setting can minimize the burden on residents and enable inclusive participation. However, it arguably creates additional burden on staff, particularly where they have a role to play in locally supporting and maintaining technology as part of data collection. Future research should examine how to measure and minimize the burden associated with data collection in remote trials. <br /><br />
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                                    <link>https://www.jmir.org/2018/6/e220</link>
                    <pubDate>Tue, 19 Jun 2018 09:30:02 EDT</pubDate>
                    <guid>https://www.jmir.org/2018/6/e220</guid>
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                    <title>Baby Boomers’ Adoption of Consumer Health Technologies: Survey on Readiness and Barriers</title>
                    <description><![CDATA[Background: As they age, baby boomers (born 1946-1964) will have increasing medical needs and are likely to place large demand on health care resources. Consumer health technologies may help stem rising health care needs and costs by improving provider-to-patient communication, health monitoring, and information access and enabling self-care. Research has not explored the degree to which baby boomers are ready for, or are currently embracing, specific consumer health technologies This study explores how baby boomers’ readiness to use various technologies for health purposes compares to other segments of the adult population. Objective: The goals of the study are to (1) examine what technologies baby boomers are ready to use for health purposes, (2) investigate barriers to baby boomers’ use of technology for health purposes, and (3) understand whether readiness for and barriers to baby boomers’ use of consumer health technologies differ from those of other younger and older consumers. Methods: Data were collected via a survey offered to a random sample of 3000 subscribers to a large pharmacy benefit management company. Respondents had the option to complete the survey online or by completing a paper-based version of the survey. Results: Data from 469 respondents (response rate 15.63%) were analyzed, including 258 baby boomers (aged 46-64 years), 72 younger (aged 18-45 years), and 139 older (age >64 years) participants. Baby boomers were found to be similar to the younger age group, but significantly more likely than the older age group to be ready to use 5 technologies for health purposes (health information websites, email, automated call centers, medical video conferencing, and texting). Baby boomers were less ready than the younger age group to adopt podcasts, kiosks, smartphones, blogs, and wikis for health care purposes. However, baby boomers were more likely than older adults to use smartphones and podcasts for health care purposes. Specific adoption barriers vary according to the technology. Conclusions: Baby boomers have commonalities with and distinctions from both younger and older adults in their readiness to adopt specific consumer health technologies and the barriers they experience to adoption. Baby boomers’ nuances regarding readiness to adopt and the barriers associated with the various forms of consumer health technology should be taken into account by those interested in promoting consumer health technologies use among baby boomers when developing applications, choosing technologies, preparing users for use, and in promotional tactics. <br /><br />
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                                    <link>https://www.jmir.org/2014/9/e200</link>
                    <pubDate>Mon, 08 Sep 2014 11:37:10 EDT</pubDate>
                    <guid>https://www.jmir.org/2014/9/e200</guid>
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                    <title>Online Self-Tracking Groups to Increase Fruit and Vegetable Intake: A Small-Scale Study on Mechanisms of Group Effect on Behavior Change</title>
                    <description><![CDATA[Background: Web-based interventions with a self-tracking component have been found to be effective in promoting adults’ fruit and vegetable consumption. However, these interventions primarily focus on individual- rather than group-based self-tracking. The rise of social media technologies enables sharing and comparing self-tracking records in a group context. Therefore, we developed an online group-based self-tracking program to promote fruit and vegetable consumption. Objective: This study aims to examine (1) the effectiveness of online group-based self-tracking on fruit and vegetable consumption and (2) characteristics of online self-tracking groups that make the group more effective in promoting fruit and vegetable consumption in early young adults. Methods: During a 4-week Web-based experiment, 111 college students self-tracked their fruit and vegetable consumption either individually (ie, the control group) or in an online group characterized by a 2 (demographic similarity: demographically similar vs demographically diverse) × 2 (social modeling: incremental change vs ideal change) experimental design. Each online group consisted of one focal participant and three confederates as group members or peers, who had their demographics and fruit and vegetable consumption manipulated to create the four intervention groups. Self-reported fruit and vegetable consumption were assessed using the Food Frequency Questionnaire at baseline and after the 4-week experiment. Results: Participants who self-tracked their fruit and vegetable consumption collectively with other group members consumed more fruits and vegetables than participants who self-tracked individually (P=.01). The results did not show significant main effects of demographic similarity (P=.32) or types of social modeling (P=.48) in making self-tracking groups more effective in promoting fruit and vegetable consumption. However, additional analyses revealed the main effect of performance discrepancy (ie, difference in fruit and vegetable consumption between a focal participant and his/her group members during the experiment), such that participants who had a low performance discrepancy from other group members had greater fruit and vegetable consumption than participants who had a high performance discrepancy from other group members (P=.002). A mediation test showed that low performance discrepancy led to greater downward contrast (b=–0.78, 95% CI –2.44 to –0.15), which in turn led to greater fruit and vegetable consumption. Conclusions: Online self-tracking groups were more effective than self-tracking alone in promoting fruit and vegetable consumption for early young adults. Low performance discrepancy from other group members lead to downward contrast, which in turn increased participants’ fruit and vegetable consumption over time. The study highlighted social comparison processes in online groups that allow for sharing personal health information. Lastly, given the small scale of this study, nonsignificant results with small effect sizes might be subject to bias. <br /><br />
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                                    <link>https://www.jmir.org/2017/3/e63</link>
                    <pubDate>Mon, 06 Mar 2017 10:45:01 EST</pubDate>
                    <guid>https://www.jmir.org/2017/3/e63</guid>
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                    <title>Internet-Delivered Early Interventions for Individuals Exposed to Traumatic Events: Systematic Review</title>
                    <description><![CDATA[Background: Over 75% of individuals are exposed to a traumatic event, and a substantial minority goes on to experience mental health problems that can be chronic and pernicious in their lifetime. Early interventions show promise for preventing trauma following psychopathology; however, a face-to-face intervention can be costly, and there are many barriers to accessing this format of care. Objective: The aim of this study was to systematically review studies of internet-delivered early interventions for trauma-exposed individuals. Methods: A literature search was conducted in PsycINFO and PubMed for papers published between 1991 and 2017. Papers were included if the following criteria were met: (1) an internet-based intervention was described and applied to individuals exposed to a traumatic event; (2) the authors stated that the intervention was intended to be applied early following trauma exposure or as a preventive intervention; and (3) data on mental health symptoms at pre-and postintervention were described (regardless of whether these were primary outcomes). Methodological quality of included studies was assessed using the Downs and Black checklist. Results: The interventions in the 7 studies identified were categorized as selected (ie, delivered to an entire sample after trauma regardless of psychopathology symptoms) or indicated (ie, delivered to those endorsing some level of posttraumatic distress). Selected interventions did not produce significant symptom improvement compared with treatment-as-usual or no intervention control groups. However, indicated interventions yielded significant improvements over other active control conditions on mental health outcomes. Conclusions: Consistent with the notion that many experience natural recovery following trauma, results imply that indicated early internet-delivered interventions hold the most promise in future prevention efforts. More studies that use rigorous methods and clearly defined outcomes are needed to evaluate the efficacy of early internet-delivered interventions. Moreover, basic research on risk and resilience factors following trauma exposure is necessary to inform indicated internet-delivered interventions. <br /><br />
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                                    <link>https://www.jmir.org/2018/11/e280</link>
                    <pubDate>Wed, 14 Nov 2018 10:00:03 EST</pubDate>
                    <guid>https://www.jmir.org/2018/11/e280</guid>
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                    <title>Are Physicians Ready for Patients With Internet-Based Health Information?</title>
                    <description><![CDATA[BACKGROUND: An increasing number of patients bring Internet-based health information to medical consultations. However, little is known about how physicians experience, manage, and view these patients.

OBJECTIVE:  This study aimed to advance the understanding of the effects of incorporating Internet-based health information into routine medical consultations from physicians&#8217; perspectives, using a qualitative approach.

METHODS: Six focus groups were conducted with 48 family physicians practising in Toronto. The data were analyzed using qualitative methods of content analysis and constant comparison, derived from grounded theory approach.

RESULTS: Three overarching themes were identified: (1) perceived reactions of patients, (2) physician burden, and (3) physician interpretation and contextualization of information. Physicians in our study generally perceived Internet-based health information as problematic when introduced by patients during medical consultations. They believed that Internet information often generated patient misinformation, leading to confusion, distress, or an inclination towards detrimental self-diagnosis and/or self-treatment. Physicians felt these influences added a new interpretive role to their clinical responsibilities. Although most of the physicians felt obliged to carry out this new responsibility, the additional role was often unwelcome. Despite identifying various reactions of patients to Internet-based health information, physicians in our study were unprepared to handle these patients.

CONCLUSION: Effective initiatives at the level of the health care system are needed. The potential of Internet-based health information to lead to better physician-patient communication and patient outcomes could be facilitated by promoting physician acknowledgment of increasing use of the Internet among patients and by developing patient management guidelines and incentives for physicians.

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                                    <link>https://www.jmir.org/2006/3/e22</link>
                    <pubDate>Fri, 29 Sep 2006 00:00:00 EDT</pubDate>
                    <guid>https://www.jmir.org/2006/3/e22</guid>
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                    <title>Unintended Consequences of Nationwide Electronic Health Record Adoption: Challenges and Opportunities in the Post-Meaningful Use Era</title>
                    <description><![CDATA[The US health system has recently achieved widespread adoption of electronic health record (EHR) systems, primarily driven by financial incentives provided by the Meaningful Use (MU) program. Although successful in promoting EHR adoption and use, the program, and other contributing factors, also produced important unintended consequences (UCs) with far-reaching implications for the US health system. Based on our own experiences from large health information technology (HIT) adoption projects and a collection of key studies in HIT evaluation, we discuss the most prominent UCs of MU: failed expectations, EHR market saturation, innovation vacuum, physician burnout, and data obfuscation. We identify challenges resulting from these UCs and provide recommendations for future research to empower the broader medical and informatics communities to realize the full potential of a now digitized health system. We believe that fixing these unanticipated effects will demand efforts from diverse players such as health care providers, administrators, HIT vendors, policy makers, informatics researchers, funding agencies, and outside developers; promotion of new business models; collaboration between academic medical centers and informatics research departments; and improved methods for evaluations of HIT.<br /><br />
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                                    <link>https://www.jmir.org/2019/6/e13313</link>
                    <pubDate>Mon, 03 Jun 2019 10:45:03 EDT</pubDate>
                    <guid>https://www.jmir.org/2019/6/e13313</guid>
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                    <title>Smartphone-Based Interventions and Internalizing Disorders in Youth: Systematic Review and Meta-analysis</title>
                    <description><![CDATA[Background: Mental health disorders in youth are a global issue that have important implications for the future quality of life and morbidity of affected individuals. In the context of public health initiatives, smartphone-based interventions have been suggested to hold the potential to be an effective strategy to reduce the symptoms of mental health disorders in youth; however, further evaluation is needed to confirm their effectiveness. This systematic review and meta-analysis documents and synthesizes existing research on smartphone-based interventions targeting internalizing disorders in youth populations. Objective: This study aims to synthesize existing research on smartphone-based interventions targeting internalizing disorders in youth populations. Methods: PubMed and SCOPUS were searched in 2019, and 4334 potentially relevant articles were found. A total of 12 studies were included in the final synthesis. We used the Hedges <i>g</i> meta-analysis approach and a random effects model for analysis. Results: The results of this review note that depression and anxiety are the most commonly targeted symptoms, and unlike other similar topics, most studies reviewed were linked to a proven treatment. The overall pooled effect from the meta-analysis showed small but significant effects (κ=12; N=1370; Hedges g=0.20; 95% CI 0.02-0.38) for interventions in reducing the symptoms of internalizing disorders. In total, 4 subgroup analyses examining specific symptoms and intervention styles found varied small significant and nonsignificant effects. Conclusions: Future research should focus on developing robust evaluative frameworks and examining interventions among more diverse populations and settings. More robust research is needed before smartphone-based interventions are scaled up and used at the population level to address youth internalizing disorders. <br /><br />
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                                    <link>https://www.jmir.org/2021/1/e16490</link>
                    <pubDate>Mon, 11 Jan 2021 09:00:04 EST</pubDate>
                    <guid>https://www.jmir.org/2021/1/e16490</guid>
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                    <title>Gaining Insights Into the Estimation of the Circadian Rhythms of Social Activity in Older Adults From Their Telephone Call Activity With Statistical Learning: Observational Study</title>
                    <description><![CDATA[<strong>Background:</strong> Understanding the social mechanisms of the circadian rhythms of activity represents a major issue in better managing the mechanisms of age-related diseases occurring over time in the elderly population. The automated analysis of call detail records (CDRs) provided by modern phone technologies can help meet  such an objective. At this stage, however, whether and how the circadian rhythms of telephone call activity can be automatically and properly modeled in the elderly population remains to be established.
<strong>Objective:</strong> Our goal for this study is to address whether and how the circadian rhythms of social activity observed through  telephone calls could be automatically modeled in older adults.
<strong>Methods:</strong> We analyzed a 12-month data set of outgoing telephone CDRs of 26 adults older than 65 years of age. We designed a statistical learning modeling approach adapted for exploratory analysis. First, Gaussian mixture models (GMMs) were calculated to automatically model each participant’s circadian rhythm of telephone call activity. Second, k-means clustering was used for grouping participants into distinct groups depending on the characteristics of their personal GMMs.
<strong>Results:</strong> The results showed the existence of specific structures of telephone call activity in the daily social activity of older adults. At the individual level, GMMs allowed the identification of personal habits, such as morningness-eveningness for making calls. At the population level, k-means clustering allowed the structuring of these individual habits into specific morningness or eveningness clusters.
<strong>Conclusions:</strong> These findings support the potential of phone technologies and statistical learning approaches to automatically provide personalized and precise information on the social rhythms of telephone call activity of older individuals. Futures studies could integrate such digital insights with other sources of data to complete assessments of the circadian rhythms of activity in elderly populations.
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                                    <link>https://www.jmir.org/2021/1/e22339</link>
                    <pubDate>Fri, 08 Jan 2021 10:45:22 EST</pubDate>
                    <guid>https://www.jmir.org/2021/1/e22339</guid>
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                    <title>Young People’s Use of Digital Health Technologies in the Global North: Narrative Review</title>
                    <description><![CDATA[<strong>Background:</strong> A diverse array of digital technologies are available to children and young people living in the Global North to monitor, manage, and promote their health and well-being.
<strong>Objective:</strong> This article provides a narrative literature review of the growing number of social research studies published over the past decade that investigate the types of digital technologies used by children and young people in the Global North, in addition to investigating which of these technologies they find most useful or not useful. Key findings as well as major gaps and directions for future research are identified and discussed.
<strong>Methods:</strong> A comprehensive search of relevant publications listed in Google Scholar was conducted, supported by following citation trails of these publications. The findings are listed under type of digital technology used for health: cross-media, internet, social media, apps and wearable devices, sexual health support and information, and mental health support and information.
<strong>Results:</strong> Many young people in the Global North are active users of digital health technologies. However, it is notable that they still rely on older technologies, such as websites and search engines, to find information. Apps and platforms that may not have been specifically developed for young people as digital health resources often better suit their needs. Young people appreciate the ready availability of information online, the opportunities to learn more about their bodies and health states, and the opportunities to learn how to improve their health and physical fitness. They enjoy being able to connect with peers, and they find emotional support and relief from distress by using social media platforms, YouTube, and online forums. Young people can find the vast reams of information available to them difficult to navigate. They often look to trusted adults to help them make sense of the information they find online and to provide alternative sources of information and support. Face-to-face interactions with these trusted providers remain important to young people. Risks and harms that young people report from digital health use include becoming overly obsessed with their bodies’ shape and size when using self-tracking technologies and comparing their bodies with the social media influencers they follow.
<strong>Conclusions:</strong> Further details on how young people are using social media platforms and YouTube as health support resources and for peer-to-peer sharing of information, including attention paid to the content of these resources and the role played by young social media influencers and microcelebrities, would contribute important insights to this body of literature. The role played by visual media, such as GIFs (Graphics Interchange Format) and memes, and social media platforms that have recently become very popular with young people (eg, Snapchat and TikTok) in health-related content creation and sharing requires more attention by social researchers seeking to better understand young people’s use of digital devices and software for health and fitness.
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                                    <link>https://www.jmir.org/2021/1/e18286</link>
                    <pubDate>Mon, 11 Jan 2021 09:30:03 EST</pubDate>
                    <guid>https://www.jmir.org/2021/1/e18286</guid>
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